States with Higher Rates of Angioplasty and Bypass Surgery Show Higher Survival Rates for Some Heart Attacks

EVANSTON, IL — Oct. 31, 2005 — States with higher rates of revascularization (angioplasty and bypass surgery) for treatment of the most severe form of heart attacks are experiencing higher survival rates, according to a new study from Solucient®, the nation's leading source of information products for the healthcare industry. The study also showed great variation by state in revascularization rates for these kinds of heart attacks.

Called a transmural acute myocardial infarction (AMI), the most severe form of heart attack affects the full thickness of the heart wall. According to the 2005 Solucient 100 Top Hospitals®: Cardiovascular Benchmarks for Success study, survival rates for patients with this type of heart attack are equally good whether they are directly admitted for revascularization or are stable enough to be transferred to another facility providing the procedures. This is noteworthy as previous research has shown that time to treatment is a critical factor in patient outcomes.

In addition, the study found that winners of the 100 Top Hospitals Cardiovascular award were more likely than peer hospitals to provide revascularization to patients with the most severe heart attacks. Published in the Oct. 31 edition of Modern Healthcare magazine, the new study also indicates that one kind of post-operative complication for all revascularized patients — post-operative hemorrhage or hematoma — is rapidly declining while another — post-operative sepsis — seems to be increasing.

"The wide variation by state in treatment of transmural AMI patients receiving angioplasty or bypass surgery is troubling, given the concurrent differences in survival rates," said Jean Chenoweth, senior vice president, performance improvement and 100 Top Hospitals programs, Solucient Center for Healthcare Improvement. "The findings raise issues pertinent to the national debate over expansion of PCI (percutaneous coronary intervention) services to hospitals without open heart units. Transfer of stabilized transmural AMI patients appears to be working. The debate should focus on the reasons why patients cannot be transferred and how we improve their outcomes."

Excluding patients transferred to another facility, the study found rates of revascularization for patients with the most severe heart attacks, adjusted for age and sex, ranged from as low as 44 percent in Hawaii to as high as 71 percent in Utah. In addition, research showed that 71 percent of transmural AMI patients at this year's typical 100 Top Cardiovascular hospital received revascularization compared to 68 percent at the typical hospital performing both PCI and CABG (coronary artery bypass graft).

Transmural AMI Revascularization Rates, by State

Treatment methods for heart attacks are changing at U.S. hospitals. "The study showed that in just six years, there has been a dramatic increase in the use of PCIs, including angioplasties, with a corresponding decrease in medical treatment," said Janet Young, M.D., M.H.S.A., senior scientist at Solucient and co-author of the study. From 1998 to 2004, use of PCIs in all AMI patients grew from 22 percent to 32 percent, while use of medical treatment during the same period fell from 67 percent to 58 percent. Rates for CABGs remained fairly constant at about 10 percent.

"Guidelines for treating AMIs are complex, dynamic and usually based on a clinical diagnostic classification system," noted Young, "so it's not surprising that there is a great deal of variation in how AMI patients are treated. Many factors must be considered, such as time to treatment, hospital and physician experience with intervention and patient risk.

"While higher rates of revascularization may be responsible for the higher survival rates among those suffering the most severe heart attacks, there are other possible explanations, such as variability in other co-morbid conditions that would affect both the risk of death and the decision to revascularize," Young pointed out. Additional research is required to confirm a cause-and-effect relationship between higher revascularization rates and higher survival.

The study also sheds light on changes in post-operative complication trends for all PCI and CABG patients. Although post-operative hemorrhage or hematoma rates have declined dramatically in recent years, post-operative sepsis appears to be on the rise. These trends are significant because both of these complications are included in the list of Patient Safety Indicators (PSIs) developed by the Agency for Healthcare Research and Quality (AHRQ) and are widely accepted as measures of hospital safety.

The annual Solucient study on cardiovascular services objectively measures performance against key criteria at the nation's top performing acute-care hospitals. Among the study's findings:

• If cardiovascular services in all acute-care hospitals performed at the same level as the hospitals with the nation's top cardiovascular services, 10,000 additional cardiovascular patients could survive each year; and an additional 1,100 patients could be complication-free.
• Winning hospitals are 23 percent less likely than non-winners to have post-operative infections and about 20 percent less likely than non-winners to have post-operative hemorrhage for patients undergoing CABG or PCI.
• Winning hospitals annually perform as much as 80 percent more bypass surgeries and PCIs, including angioplasties, as their peers.
• Cardiovascular patients at winning hospitals return to everyday life faster than those at non-winning hospitals. Patients at the winning hospitals were released more than a half-day earlier than patients at peer hospitals.
• Average cardiovascular-related costs for benchmark hospitals were nearly 15 percent lower than at peer hospitals.

The seventh edition of the Solucient 100 Top Hospitals®: Cardiovascular Benchmarks for Success study analyzed acute-care hospitals nationwide using detailed empirical performance data from publicly available 2003 Medicare cost reports and 2003 and 2004 Medicare MedPAR data. The measures were calculated for three classes of hospitals with the following number of winners in each:

• Teaching with Cardiovascular Residency Programs, 30 winners
• Teaching without Cardiovascular Residency Programs, 40 winners
• Community, 30 winners

Solucient® scored facilities in seven key performance areas: risk-adjusted medical mortality, risk-adjusted surgical mortality, complications, percentage of CABG patients with internal mammary artery use, procedure volume, severity-adjusted average length of stay, and wage and severity-adjusted average cost.

Media Notes:
More information on these studies and other 100 Top Hospitals research is available at www.100tophospitals.com. An executive summary of the 100 Top Hospitals: Cardiovascular Benchmarks for Success study is available to the media by emailing gsexton@solucient.com or by registering at http://www.100tophospitals.com/media/Register.asp. To schedule an interview with Jean Chenoweth, senior vice president, performance improvement and 100 Top Hospital programs, Solucient Center for Healthcare Improvement, contact Ginny Sexton at (847) 424-4358 or gsexton@solucient.com.

About Solucient
Solucient® is an information products company serving the healthcare industry. It is the market leader in providing tools and vital insights that healthcare managers use to improve the performance of their organizations.

By integrating, standardizing and enhancing healthcare information, Solucient provides comparative measurements of cost, quality and market performance. Solucient's expertise and proven solutions enable providers, payers and pharmaceutical companies to drive business growth, manage costs and deliver high quality care. For more information, visit www.solucient.com.

2005 Solucient’s 100 Top Hospitals®: Cardiovascular Award Winners
Note: Order does not reflect performance ranking. Hospitals are ordered by Medicare ID.

Teaching Hospitals with Cardiovascular Residencies (30)
Banner Good Samaritan Medical Center, Phoenix, AZ
Mayo Clinic Hospital, Phoenix, AZ
Hospital of St. Raphael, New Haven, CT
Bridgeport Hospital, Bridgeport, CT
Yale-New Haven Hospital, New Haven, CT
Advocate Lutheran General Hospital, Park Ridge, IL
Baystate Medical Center, Springfield, MA
Beth Israel Deaconess Medical Center, Boston, MA
Lahey Clinic, Burlington, MA
Providence Hospital and Medical Center, Southfield, MI
University of Michigan Hospitals and Health Centers, Ann Arbor, MI
Henry Ford Hospital, Detroit, MI
William Beaumont Hospital-Royal Oak, Royal Oak, MI
Abbott Northwestern Hospital, Minneapolis, MN
St. Luke's Hospital of Kansas City, Kansas City, MO
University Hospital, Cincinnati, OH
Good Samaritan Hospital, Dayton, OH
University Hospitals of Cleveland, Cleveland, OH
Cleveland Clinic Foundation, Cleveland, OH
UPMC Presbyterian, Pittsburgh, PA
Lankenau Hospital, Wynnewood, PA
Penn Presbyterian Medical Center, Philadelphia, PA
Penn State Milton S. Hershey Medical Center, Hershey, PA
Rhode Island Hospital, Providence, RI
Baylor University Medical Center, Dallas, TX
Scott and White Memorial Hospital, Temple, TX
Memorial Hermann Hospital, Houston, TX
LDS Hospital, Salt Lake City, UT
University of Virginia Medical Center, Charlottesville, VA
University of Wisconsin Hospital and Clinics, Madison, WI

Teaching Hospitals without Cardiovascular Residencies (40)
DCH Regional Medical Center, Tuscaloosa, AL
St. Joseph's Hospital and Medical Center, Phoenix, AZ
Morton Plant Hospital, Clearwater, FL
Carle Foundation Hospital, Urbana, IL
St. James Hospital and Health Centers, Olympia Fields, IL
Methodist Medical Center of Illinois, Peoria, IL
Mercy Medical Center-North Iowa, Mason City, IA
Union Memorial Hospital, Baltimore, MD
Oakwood Hospital and Medical Center-Dearborn, Dearborn, MI
St. Joseph Mercy Hospital Oakland, Pontiac, MI
Spectrum Health Hospitals, Grand Rapids, MI
St. Joseph Mercy Hospital, Ann Arbor, MI
Mount Clemens General Hospital, Mount Clemens, MI
North Memorial Health Care, Robbinsdale, MN
St. Mary's Medical Center, Duluth, MN
St. Cloud Hospital, St. Cloud, MN
United Hospital, St. Paul, MN
Methodist Hospital, St. Louis Park, MN
St. Joseph's Hospital, St. Paul, MN
Deaconess Billings Clinic, Billings, MT
St. Vincent Healthcare, Billings, MT
St. Peter's Hospital, Albany, NY
Rochester General Hospital, Rochester, NY
Mission Hospitals, Asheville, NC
MeritCare Hospital, Fargo, ND
Summa Health System, Akron, OH
Akron General Medical Center, Akron, OH
Toledo Hospital, Toledo, OH
The Christ Hospital, Cincinnati, OH
Bethesda North Hospital, Cincinnati, OH
Legacy Good Samaritan Hospital and Medical Center, Portland, OR
Hamot Medical Center, Erie, PA
Robert Packer Hospital, Sayre, PA
Jackson-Madison County General Hospital, Jackson, TN
Wellmont Holston Valley Medical Center, Kingsport, TN
St. Thomas Health Services, Nashville, TN
Centra Health, Lynchburg, VA
Deaconess Medical Center, Spokane, WA
St. Joseph's Hospital, Marshfield, WI
Gundersen Lutheran Health System, La Crosse, WI

Community Hospitals (30)
Southeast Alabama Medical Center, Dothan, AL
Sun Health Boswell Memorial Hospital, Sun City, AZ
Arizona Heart Hospital, Phoenix, AZ
Penrose-St. Francis Health Services, Colorado Springs, CO
Lee Memorial Health System, Fort Myers, FL
NCH Naples Campus, Naples, FL
Munroe Regional Medical Center, Ocala, FL
Sarasota Memorial Hospital, Sarasota, FL
Baptist Hospital, Pensacola, FL
St. Joseph's Hospital of Atlanta, Atlanta, GA
Sherman Hospital, Elgin, IL
Rush North Shore Medical Center, Skokie, IL
St. Francis Hospital and Health Center, Blue Island, IL
Central DuPage Hospital, Winfield, IL
Willis-Knighton Medical Center, Shreveport, LA
St. Joseph Medical Center, Towson, MD
Fairview Southdale Hospital, Edina, MN
Mercy Hospital, Coon Rapids, MN
St. Patrick Hospital and Health Sciences Center, Missoula, MT
Vassar Brothers Medical Center, Poughkeepsie, NY
Southwest General Health Center, Middleburg Heights, OH
Rogue Valley Medical Center, Medford, OR
Westmoreland Regional Hospital, Greensburg, PA
Mercy Hospital-Scranton, Scranton, PA
Memorial Hospital, Chattanooga, TN
Parkwest Medical Center, Knoxville, TN
Providence Health Center, Waco, TX
South Austin Hospital, Austin, TX
Heart Hospital of Austin, Austin, TX
Providence Everett Medical Center, Everett, WA